The Development of Nursing Care Model for Severe Trauma Patient in Emergency Department Yasothon Hospital

Abstract

This research and development aims to develop a nursing model for severe trauma patients in the emergency department Yasothon Hospital operated from 1 August 2022 to 31 May 2023, divided into 3 phases: 1) Analyzing the context and problem conditions 2) Developing the model 3) Studying the efficiency of the model .The sample consisted of 19 registered nurses working in the Emergency Department, 50 severe trauma patients' medical records before using the model, 59 severe trauma patients during the use of the model. The instruments used for collecting data were 1) the nursing model for severe trauma patients 2) Nursing quality record form 3) Data collection tools are: injury surveillance record form, nursing competency assessment form and a satisfaction assessment form. Data were analyzed using the descriptive statistic, independent t-test, and chi-square.

            The developed nursing model for severe trauma patients consisted of 1) Nursing practice guidelines for severe trauma patients. 2) Development of nurses' competencies 3) Organization of care processes and 4) Knowledge management. After conducting activities according to the pattern, it was found the statistically significant differences at the p < .05: The triage accuracy rates increased from 82.00 percent to 98.31 percent. The average time to emergent blood collection with grade 3-4 shock patients decreased from 37.08 minutes to 12.30 minutes. The average time to blood transfusion in grade 3-4 shock patients decreased from 80.04 minutes to 41.54 minutes. The percentage of patients receiving continuous monitoring increased from 74.00 percent to 89.83 percent. Mortality rate within 24 hours decreased from 22.00 percent to 8.47 percent and mortality rate in patients with Ps > 0.75 decreased from 16.22 percent to 2.28 percent. However, there were none statistically significant differences included the percentage of patients undergoing surgery within 60 minutes increased from 25.00 percent to 100.00 percent. The percentage of patients in the emergency room < 2 hours increased from 66.00 percent to 76.27 percent, the incidence of deterioration during care/transfer decreased from 3 cases to 1 case and mortality rate decreased from 26.00 percent to 20.34 percent. The competency of nurse practitioners had an increased from 3.84 points to 4.14 points, significantly (p < .05). The satisfaction with the nursing model was at a high level.

            Conclusion: The nursing care model for severe trauma patients can appropriate care in all process, decreased the mortality rate and the staff are satisfaction.